Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines

Objective: To develop cases of preference-sensitive care and analyze the individualized cost-effectiveness of respecting patient preference compared to guidelines.

Methods: Four cases were analyzed comparing patient preference to guidelines: (a) high-risk cancer patient preferring to forgo colonoscopy; (b) decubitus patient preferring to forgo air-fluidized bed use; (c) anemic patient preferring to forgo transfusion; (d) end-of-life patient requesting all resuscitative measures. Decision trees were modeled to analyze cost-effectiveness of alternative treatments that respect preference compared to guidelines in USD per quality-adjusted life year (QALY) at a $100,000/QALY willingness-to-pay threshold from patient, provider and societal perspectives.

Results: Forgoing colonoscopy dominates colonoscopy from patient, provider, and societal perspectives. Forgoing transfusion and air-fluidized bed are cost-effective from all three perspectives. Palliative care is cost-effective from provider and societal perspectives, but not from the patient perspective.

Conclusion: Prioritizing incorporation of patient preferences within guidelines holds good value and should be prioritized when developing new guidelines.     

The relation of risk attitudes and other-regarding preferences: A within-subjects analysis

In this paper we provide experimental evidence on the relation of individual risk attitudes and subjects׳ aversion to favorable inequality. In a within-subjects design we expand Blanco et al.׳s (2011) modified dictator game by the risk-elicitation task of Eckel and Grossman (2002). Our data show strong support for a significant negative correlation between risk tolerance and an aversion to favorable inequality. The results are independent of gender, i.e., women and men show a similar correlation in these traits.     

Beyond mobile number portability: measuring consumer preferences for service portability in Japan's mobile phone market

Japan's mobile phone market has been oligopolized by three incumbents who are seeking vertically integrated business models, which may prevent competitors from using platform layers to provide original services. We conduct two types of conjoint analysis to measure consumer stated preferences and draw two main conclusions from the analyses. First, the average consumer is willing to pay more than JPY 2000 (US $20) to increase mobile service portability. Second, the average consumer's willingness to pay corresponds to JPY 100–200 (US $1–2) per song for securing music download platforms. A dilemma exists in consumer preferences for service portability in Japan's mobile phone market, namely the choice between free mobile service portability and convenient music download platforms.     

The geometry of distributional preferences and a non-parametric identification approach: The Equality Equivalence Test

This paper proposes a geometric delineation of distributional preference types and a non-parametric approach for their identification in a two-person context. It starts with a small set of assumptions on preferences and shows that this set (i) naturally results in a taxonomy of distributional archetypes that nests all empirically relevant types considered in previous work; and (ii) gives rise to a clean experimental identification procedure – the Equality Equivalence Test – that discriminates between archetypes according to core features of preferences rather than properties of specific modeling variants. As a by-product the test yields a two-dimensional index of preference intensity.     

A conjoint analysis of farmer preferences for community forestry contracts in the Sumber Jaya Watershed, Indonesia

A wide range of policy instruments have been devised and applied to support the goals of sustainable forestry management. Community forestry programs can contain elements of several of those instruments. This paper considers the design of community forestry contracts in the Sumber Jaya area of Indonesia where community forestry contracts are agreements between the Forestry Department and community groups that provide group members with time-bound leasehold rights to protection forests, on the condition that farmers abide by specified land-use restrictions and pay any required fees. Farmers perceive that the contracts represent a bundle of restrictions and inducements, some of which are explicitly stated in the contract and others that are implied by the contract. Conjoint analysis was used to quantify farmers' tradeoffs among the explicit and implicit attributes of the contracts. The results of logit and ordered logit models show that farmers are most concerned about the length of the contract, and relatively unconcerned about requirements on tree density and species composition. An implicit attribute, greater access to forestry and agroforestry extension, emerges as an important implicit attribute. The results imply that farmers in this part of Indonesia would be willing to abide by fairly strict limitations on land use, provided that they can be assured of long-term rights to the planted trees.     

A tangent cone analysis of smooth preferences on a topological vector space

Summary. A theory of smooth preferences on a locally convex, topological vector space is developed by characterizing the existence of a unique supporting hyperplane to a convex set at a given point. The results are expressed in terms of the tangent cone. A new concept of properness, called strict properness, is also proposed to characterize the existence of a strictly supporting hyperplane to a convex set at a given point. We say that strict preferences are properly smooth at a given point provided that they are smooth, strictly proper, and the secant cone has a non-empty interior. Proper smoothness is broadly consistent with Gâteaux-differentiable utility even when the preference domain has an empty interior. Yet proper smoothness also allows the possibility of incomplete or intransitive preferences. This concept has immediate applications to optimization and equilibrium theory. For example, we demonstrate a version of the Second Welfare Theorem for agents with properly smooth preferences.Received: 25 September 2002; revised version: February 5, 2003, Revised: 5 February 2003, JEL Classification Numbers: D46, D51.     

Heterogeneous preferences and in-kind redistribution: Theory and evidence

This paper examines the impact of social heterogeneity on in-kind redistribution. We contribute to the previous literature in two ways: we consider (i) the provision of several public goods and (ii) agents different not only in income, but also in their preferences over the various goods provided by the public sector. In this setting, both the distribution and size of goods provision depend on the heterogeneity of preferences. Our main result is that preference heterogeneity tends to decrease in-kind redistribution, while income inequality tends to increase it. An empirical investigation based on United States Census Bureau data confirms these theoretical findings.     

Patent text mining and informetric-based patent technology morphological analysis: an empirical study

Patent technology morphological analysis utilises the advantages of both patent information analysis and morphological analysis to provide more detailed information on current and future patent technology. Current patent technology morphological analysis methods are largely reliant on manual expertise in the construction of morphological boxes with few approaches to the evaluation of future morphological configurations. We developed a patent text mining and informetric-based patent technology morphological analysis technique. We defined the basic parameters of the morphological box as the factors in factor analysis, with a patent keywords matrix, and the clusters in clustering analysis with factor scores. Patent citation, year of patent registration, keyword frequency, and contributing factors were used to evaluate future morphological configurations. We used an empirical study of liquid crystal display wide viewing angle patents to validate our method. The Thomson Reuters Derwent Innovation Index was used to collect patent text datasets. Our study indicates that this method is feasible for the implementation of patent technology morphological analysis. Our method provides advantages in terms of cost and time reductions during morphological box construction and more flexible methods for evaluating morphological configurations. We discuss problems and possible development of our method in the last section.     

Social preferences and public economics: Mechanism design when social preferences depend on incentives

Social preferences such as altruism, reciprocity, intrinsic motivation and a desire to uphold ethical norms are essential to good government, often facilitating socially desirable allocations that would be unattainable by incentives that appeal solely to self-interest. But experimental and other evidence indicates that conventional economic incentives and social preferences may be either complements or substitutes, explicit incentives crowding in or crowding out social preferences. We investigate the design of optimal incentives to contribute to a public good under these effects would make either more or less use of explicit incentives, by comparison to a naive planner who assumes they are absent.     

Forecasting future demand for large-screen television sets using conjoint analysis with diffusion model

The methodological framework proposed in this paper addresses two limitations of the basic Bass diffusion model: that it does not reflect competition among products nor does it forecast demand for products that do not exist in the marketplace. The model consists of four steps. First, to investigate consumer preferences for product attributes, we use conjoint analysis to estimate the utility function of consumers. Next we estimate the dynamic price function of each competing product to reflect technological changes and the evolving market environment. Then we derive dynamic utility function by combining the static utility function and the price function. Finally, we forecast the sales of each product using estimated market share and sales data for each period, which are derived from the dynamic utility function and from the Bass diffusion model, respectively.We apply this model to South Korea's market for large-screen televisions. The results show that (1) consumers are sensitive to picture resolution and cost and (2) in the near future, should the market see the introduction of liquid crystal display (LCD) TVs with screens larger than 50 inches, the high resolution and steep price drop of LCD will lead LCD TVs to capture a larger market share than TVs with other display types. Finally, our results show that TVs with 40-inch screens are preferred over TVs with larger screens.     

基于联合分析的新产品市场占有率预测——学生笔记本电脑市场的实证分析

市场竞争日趋激烈,企业要想在市场竞争中立于不败之地,在开发一种新产品时,势必要预测新产品在市场上的份额,本文在简述联合分析基本原理的基础上,以开发学生笔记本电脑市场的新产品为例,采用联合分析方法中的最大效用值法来预测新产品的市场占有率。     

Quasi-linear preferences in the macroeconomy: Indeterminacy,heterogeneity and the representative consumer

We use aggregation theory to investigate the link between one-consumer and multi-consumer economies under a quasi-linear class of preferences. Our study is carried out in the context of the neoclassical growth model. The quasi-linear preferences considered are additive in consumption and leisure and linear in leisure. We first show that in a homogeneous agents economy, the individual hours worked are not uniquely determined. We then demonstrate that the indeterminacy can be resolved by introducing heterogeneity. For example, idiosyncratic shocks to productivities or imperfect substitutability of labor restore the uniqueness of equilibrium. As a special case, our analysis includes the indivisible labor model by Hansen (1985).JEL Classification: C73, D90, E21We are grateful to Morten Ravn for his guidance. We have benefited from the comments of an anonymous referee, Jordi Caballé, Finn Kydland, Franck Portier, Michael Reiter, Xavier Sala-i-Martin, William Schworm and Andrew Scott. Any remaining errors are ours. This research was supported by the Instituto Valenciano de Investigaciones Económicas and the Ministerio de Ciencia y Tecnología de España, the Ramón y Cajal program, and BEC 2001-0535.     

Networked innovation and coalition formation: the effect of group-based social preferences

In this paper, we study the production and dissemination of public knowledge goods, such as technological knowledge, generated by a network of voluntarily cooperating innovators. We develop a private-collective model of public knowledge production in networked innovation systems, where group-based social preferences have an impact on the coalition formation of developers. Our model builds on the large empirical literature on voluntary production of pooled public knowledge goods, including source code in communities of software developers or data provided to open access data repositories. Our analysis shows under which conditions social preferences, such as ‘group belonging’ or ‘peer approval’, influence the stable coalition size, as such rationalising several stylized facts emerging from large-scale surveys of open-source software developers, previously unaccounted for. Furthermore, heterogeneity of social preferences is added to the model to study the formation of stable but mixed coalitions.     

A discrete choice experiment to determine UK patient preference for attributes of disease modifying treatments in Multiple Sclerosis

Aims: The recent licensing of Disease Modifying Treatments (DMTs) for Multiple Sclerosis (MS) has increased available treatment options. The aim of this study was to explore MS patients’ preference for the different attributes of DMTs in the UK.

Materials and methods: Attributes (treatment characteristics) for inclusion in the discrete choice experiment (DCE) were determined through published literature and interviews with 12 people with MS. Seven attributes were selected. Participants were presented with three hypothetical treatment options sampled from included attributes and asked for their most/least preferred options. The influence of patient characteristics and demographics on patient preference was also investigated.

Results: The DCE was completed by 350 people with MS (81% female, mean age?=?39). Results showed that method of taking medication was the strongest determinant of preference (27%; relative importance out of 100%), followed by relapse free rate (21%) and symptom progression (14%). Risk of fatigue (8%) and type of monitoring (6%) were the weakest determinants of preference. Once-daily oral treatment was preferred over all other methods of administration. Participant characteristics did not influence data on strength of preference.

Limitations: This study assumed adequate participant understanding of the discrete choice experiment task, and recruitment targeted those with access to the internet.

Conclusions: These results, derived from people with MS in the UK, should be used to inform individual discussions with patients about DMT choices.     

Cost analysis of the treatments for patients with advanced Parkinson's disease: SCOPE study

Abstract

Objective:

To perform a comparative long-term analysis of the associated healthcare costs for the therapeutic options in advanced Parkinson’s Disease (PD): deep brain stimulation (DBS), continuous duodenal levodopa-carbidopa infusion (CDLCI), and continuous subcutaneous apomorphine infusion (CSAI).     

Heterogeneity in preferences for redistribution and public spending: A cross-country analysis

Political coordination and policy outcomes may be the result not only of the position of the ‘median voter’ in a political scale but also of the heterogeneity of preferences around the median. Depending on the level of government and the type of policy, such heterogeneity may lead to lower public spending and redistribution. We assess this issue empirically by analyzing the relationship between the distribution of preferences for redistribution and the amount of public expenditure at different levels of government and for several types of spending in 23 European countries. Our results suggest a negative and significant correlation between heterogeneity of preferences for redistribution and public spending that is stronger at the local level and for redistributive functions, independent of the median individual's preferences.     

Heterogeneous treatment effects and mechanisms in information-based environmental policies: Evidence from a large-scale field experiment

Policymakers often rely on non-pecuniary, information-based programs to achieve social objectives. Using data from a water conservation information campaign implemented as a randomized controlled trial, we estimate heterogeneous household responses. Understanding such heterogeneity is important for improving the cost-effectiveness of non-pecuniary programs, extending them to other populations and probing the mechanisms through which the treatment effects arise. We find little evidence of heterogeneous responses to purely technical information or to traditional conservation messages that combine technical information and moral suasion. In contrast, norm-based messages that combine technical information, moral suasion and social comparisons exhibit strong heterogeneity: households that are wealthier, owner-occupied and use more water are more responsive. These subgroups tend to be least responsive to pecuniary incentives. We find no evidence that any subgroup increases their water use in response to the messages. By targeting the messages to subgroups known to be most responsive, program costs could be reduced by over 50% with only a 20% reduction in the treatment effect. Combining theory and data, we also shed light on the mechanisms through which the treatment effects arise, which has implications for program design and future research on the program's welfare effects.     

Information provision and preferences for education spending: Evidence from representative survey experiments in three countries

Do citizens' preferences about education policies differ across industrialized countries? To gain comparative evidence on public preferences for education spending, we conduct representative experiments with information treatments in Switzerland using identical survey techniques previously used in Germany and the United States. In Switzerland, providing information about actual spending and salary levels reduces support for increased education spending from 54 to 40 percent and for increased teacher salaries from 27 to 19 percent, respectively. The broad patterns of education policy preferences are similar across the three countries when the role of status-quo and information are taken into account.     

How economic growth becomes a cost: The scarcity multiplier

Competent macro-allocation of natural capital would allow micro-allocation by economics to be fully useful and may help prevent the latter being confused with the former. This macro-allocation requires social choice, so to see whether it is likely to be competent the effectiveness of democratic politics is investigated. Dysfunction is predicted because democratic institutions produce elements of irresponsibility and ignorance. These permit inflation of want by supply (IWS), a positive feedback in which wants are increased by their supply, provoking more supply, hence more want. Four IWS systems combine under common conditions to indefinitely escalate the scarcity of natural capital, a crucial failure of macro-allocation. This ‘scarcity multiplier' causes apparently rational attempts to satisfy a few wants to exacerbate many, increasing dissatisfaction. Institutions for deliberative public participation may enable democracies to recognize and control IWS. Unless this is done the scarcity multiplier may make cost-benefit analysis misleading: it may make the costs of development projects exceed their benefits in proportion to their financial success.